Occupational and

Environmental MedicineAdopted as the Journal of the Faculty of

Occupational Medicine of the Royal CoUege ofPhysicians ofLondon

Editor: Anne Cockcroft (United Kingdom)Deputy Editor:T C Aw (United Kingdom)Technical Editor:Judith HaynesEditorial Assistant: Rachel HarveyEditorial Board: R McNamee (United Kingdom) D C Snashall (United Kingdom)F J H Van Dijk (Holland) J Myers (South Africa) G Theriault (Canada)D Heederik (Holland) B Nemery (Belgium) KM Venables (United Kingdom)J Jeyaratnam (Singapore) M J Nieuwenhuijsen (United Kingdom) J-D Wang (Taiwan)G Lemasters (United States) T Okubo Japan) P Westerholm (Sweden)G Liss (Canada) H Roels (Belgium) Editor, British MedicaljournalR L Maynard (United Kingdom) M Sim (Australia)

NOTICE TO CONTRIBUTORS Occupational and Environmental Medicneis intended for the publication of original contributions relevant tooccupational and environmental medicine including toxicologicalstudies of chemicals of industrial, agricultural, and environmentalimportance, and epidemiological studies. As well as full papers,short papers dealing with brief or preliminary observations relevantto occupational and environmental medicine will also beconsidered. Case reports should cover substantial new ground tomerit publication. Other articles, including review or positionpapers, will be considered but should not be submitted without firstapproaching the Editor to discuss their suitability for the Journal.Letters to the Editor are always welcome. The website address forthe Journal is:-http://www.occenvmed.comINSTRUCTIONS TO AUTHORS Three copies of all submissions shouldbe sent to: The Editor, Occupational and Environmental Medicine,BMJ Publishing Group, BMA House, Tavistock Square, LondonWC1H 9JR, UK. All authors should sign the covering letter as evi-dence of consent to publication. Papers reporting results of studieson human subjects must be accompanied by a statement that thesubjects gave written, informed consent and by evidence ofapproval from the appropriate ethics committee. These papersshould conform to the principles outlined in the Declaration ofHelsinki (BMJ 1964;ii: 177).

If requested, authors shall produce the data on which the manu-script is based, for examination by the Editor.Authors are asked to submit with their manuscript the

names and addresses of three people who they considerwould be suitable independent reviewers. They will not nec-essarily be approached to review the paper.

Papers are considered on the understanding that they aresubmitted solely to this Journal and do not duplicate materialalready published elsewhere. In cases of doubt, where part of thematerial has been published elsewhere, the published materialshould be included with the submitted manuscript to allow theEditor to assess the degree of duplication. The Editor cannot enterinto correspondence about papers rejected as being unsuitable forpublication, and the Editor's decision in these matters is final.Papers should include a structured abstract of not more

than 300 words, under headings of Objectives, Methods,Results, and Conclusions. Please include up to threekeywords or key terms to assist with indexing.

Papers should follow the requirements of the InternationalCommittee of Medical Journal Editors (JAMA 1993;269:2282-6).Papers and references must be typewritten in doubk spacing on oneside of the paper only, with wide margins. SI units should be used.

Short reports (including case reports) should be not more than1500 words including a brief abstract. They should comprisesections of Introduction, Methods, Results, and Discussion with notmore than one table or figure and up to 10 references. The formatofcase reports should be Introduction, Case report, and Discussion.

mustratlons Photographs and photomicrographs on glossy papershould be submitted unmounted. Charts and graphs should becarefully drawn in black ink on firm white paper. Legends to figuresshould be typed on a separate sheet of paper.References References will not be checked by the editorial office;responsibility for the accuracy and completeness of references lieswith the authors. Number references consecutively in the order inwhich they are first mentioned in the text. Identify references intexts, tables, and legends by Arabic numerals. References cited only

in tables or in legends to figures should be numbered in accordancewith a sequence established by the first identification in the text of aparticular table or illustration. Include only references essential to theargument being developed in the paper or to the discussion of results,or to describe methods which are being used when the originaldescription is too long for inclusion. Information from manuscriptsnot yet in press or personal communications should be cited in thetext, not as formal references.Use the Vancouver style, as in this issue for instance, for a standardjournal article: authors (list all authors when seven or fewer, wheneight or more, list only six and add et at), tide, abbreviated tide of jour-nal as given in Index Medicus (if not in Index Medicus give in full), yearof publication, volume number, and first and last page numbers.Proofs Contributors will receive one proof. Only minor correctionscan be made at this stage, corrections other than printer's errors maybe charged to the author.

0

Reprints Reprints will be charged for. The number of reprintsrequired should be stated on the form provided with the proofs.Copyright C 1997 Occupational and Environmental Medicine. Thispublication is copyright under the Berne Convention and theInternational Copyright Convention. All rights reserved. Apart fromany relaxations permitted under national copyright laws, no part of dhispublication may be reproduced, stored in a retrieval system, or trans-mitted in any form or by any means without the prior permission ofthecopyright owners. Permission is not, however, required to copyabstracts ofpapers or of articles on condition that a full reference to thesource is shown. Multiple copying of the contents of the publicationwithout permission is always illegal.NOTICE TO ADVERTISERS Applications for advertisement space and forrates should be addressed to the Advertisement Manager, Occupatonaland Environmental Medicine, BMJ Publishing Group, BMA House,Tavistock Square, London WClH 9JRNOTICE TO SUBSCRIBERS Occupational and Environmental Medicine ispublished monthly. The annual subscription rate (for 1997) is £164(US $244). Orders should be sent to the Subscription Manager,Occupational and EnvironmentalMedicine, BMJ Publishing Group, POBox 299, London WC1H 9TD. Orders may also be placed with anyleading subscription agent or bookseller. (For the convenience ofreaders in the USA subscription orders with or without payment mayalso be sent to BMJ Publishing Group, PO Box 590A, Kennebunk-port ME 04046, USA. All inquires, however, must be addressed tothe publisher in London). All inquiries regarding air mail rates andsingle copies already published should be addressed to the publisherin London.Subscribers may pay for their subscriptions by Access, Visa, orAmerican Express by quoting on their order the credit or charge cardpreferred together with the appropriate personal account number andthe expiry date of the card.Periodicals postage paid Rahway NJ. Postmaster: send addresschanges to: Occupational and Environmental Medicine, c/o MercuryAirfreight International Ltd Inc. 2323 Randolph Avenue, Avenel, NJ07001, USA.FACULTY OF OCCUPATIONAL MEDICINE The Faculty of OccupationalMedicine of the Royal College ofPhysicians ofLondon is a registeredcharity founded to promote, for the public benefit, the advancementof knowledge in the field of occupational medicine. The Faculty hasoffices at 6 St Andrew's Place, Regent's Park, London NW1 4LB.ISSN 1351 0711.

Published by BMJ PublishingGroup, and printed inEngland on acid free paperby Thanet Press Limited,Margate, Kent

Tomenson, Bonner, Heiyne, Farrar, Cummings

8 Hearne FF, Pifer JW, Grose F. Absence of adverse mortalityeffects in workers exposed to methylene chloride: an

update. Occup Med 1990;32:234-40.9 Ott MG, Skory LK, Holder BB, Bronson JH, Williams PR.

Health evaluation of employees occupationally exposed tomethylene chloride. ScandJ7 Work Environ Health 1983;9: 1-38.

10 Lanes SF, Cohen A, Rothman KJ, Dreyer NA, Soden KJ.Mortality of cellulose fiber production workers. Scand IWork Environ Health 1990;16:247-51.

11 Rothman KJ, Dreyer NA, Soden KJ. Mortality update ofcellulose fiber production workers. Scand JVWork EnvironHealth 1993;19:426-8.

12 Gibbs GWAmsel J, Soden K. A cohort mortality study ofcellulose triacetate fiber workers exposed to methylenechloride. Occup Environ Med 1996;38:693-7.

13 World Health Organisation. Manual of the internationalclassification of diseases, injuries and causes of death, 8th rev.

Geneva: WHO, 1967.14 World Health Organisation. Manual of the international

classification of diseases, injuries and causes of death, 9th rev.

Geneva: WHO, 1977.15 Marsh GM, Preininger M. OCMAP: a user-oriented occu-

pational cohort mortality analysis program. American Stat-istician 1980;34:245.

16 Gardner MJ, Winter PD, Barker DJP. Atlas of mortalityfromselected diseases in England and Wales 1968-78. Chichester:John Wiley, 1984.

17 Hakulinen T. A Mantel-Haenszel statistic for testing theassociation between polychotomous exposure and a rare

outcome. Am Epideniol 1981;113:192-6.18 Kristensen TS. Cardiovascular diseases and the work

environment: a critical review of the epidemiologicliterature on chemical factors. ScandJ Work Environ Health1989;15:245-64.

19 Ott MG, Carlo GL, Steinberg S, Bond GG. Mortalityamong employees engaged in chemical manufacturing andrelated activities. AmJ Epidemiol 1985;122:311-22.

20 Heineman EF, Cocco P, Gomez MR, Dosemeci M, StewartPA, Hayes RB, et al. Occupational exposure to chlorinatedaliphatic hydrocarbons and risk of astrocytic brain cancer.Am J Ind Med 1994;26:155-69.

21 Stern FB, Halperin WE, Hornung RW, Ringenburg VL,McCammon CS. Heart disease mortality among bridgeand tunnel officers exposed to carbon monoxide. AmJ Epi-demiol 1988;128:1276-88.

22 Soden KJ. An evaluation of chronic methylene chlorideexposure. Y Occup Med 1993;35:282-6.

23 Cherry N, Venables H, Waldron HA, Wells GG. Someobservations on workers exposed to methylene chloride. BrJlIndMed 1981;38:351-5.

Appendix: Estimated exposures (8h TWA,ppm) for selected work groups

Period

BeforeWork group 1960 1960-9 1970-9 1980-8

Dope section 20 50 165 73Operator (D

block) - 127 127 88Operator (B/C

blocks) 16 24 54 32Solvent recovery 6 16 53 27Cleaning 7 22 46 25Subwash operator 2 6 19 10Laboratory 4 6 10 7

Rejected manuscriptsFrom February 1994, authors whose be returned to them. The Journal will destroysubmitted articles are rejected will be advised remaining copies of the article but corres-of the decision and one copy of the article, pondence and reviewers' comments will betogether with any reviewer's comments, will kept.

476

Effects of low level exposure to lead on neurophysiologicalfunctions among lead battery workers

27 Murata K, Araki S, Aono H. Effects of lead, zinc, and cop-

per absorption on peripheral nerve conduction in metalworkers. Int Arch Occup Environ Health 1987;59: 11-20.

28 Yeh JH, Chang YC, Wang JD. Combined electroneuro-graphic and electromyographic studies in lead workers.Occup Environ Med 1995;52:415-9.

29 Beritic T. Lead neuropathy. Crit Rev Toxicol 1984;12:149-213.

30 Halonen P. Halonen J-P, Lang HA, Karskela V. Vibratoryperception thresholds in shipyard workers exposed tosolvents. Acta Neurol Scand 1986;73:561-5.

31 Jeyaratnam J, Devathasan G, Ong CN, Phoon WO, WongPK. Neurophysiological studies on workers exposed tolead. BrJ Ind Med 1985;42:173-7.

32 Burchfield IL, Duffy FH, Bartels PH, Needleman HL. Thecombined discriminating power of quantitative electroen-cephalography and neurophysiological measures in evalu-ating nervous system effects of lead at low levels. In:Needleman HL, ed. Low level lead exposure: the clinicalimplications of current research. New York: Raven Press,1980:75-89.

33 Benignus VA, Otto DA, Muller KE, Seiple KJ. Effects of ageand body lead burden on CNS functioning in youngchildren II. EEG spectra. Electroencephalogr Clin Neuro-physiol 1981;52:240-8.

34 Santamaria J, Chiappa KH. The EEG drowsiness in normaladults. Clin Neurophysiol 1987;4:327-82.

35 Kojima T, Shimanozo Y, Ichise K, Atsumi Y, Ando H, AutoK. Eye movement as an indicator of brain function. FoliaPsychiatrica et Neurologica J7aponica 198 1;35:425-36.

Occupational and Environmental Medicine and theelectronic ageOEM has an Email address which is Our publishing system is now fully100632.3615@compuserve.com. We wel- electronic, and authors are sending theircome contact by Email, including letters to the revised copy to us on disk as well as paper.editor. Some of our reviewers already send us Watch for revised Instructions to Authors.their reports by Email, helping to speed up the The Editorpeer review process.

493

Friis, Vaghef, Edling, Hellman

12 Fairbairn DW, Olive PL, O'Neill KL. The comet assay: acomprehensive review. Mutat Res 1995;339:37-59.

13 Hellman B, Vaghef H, Friis L, Edling C. Alkaline single cellgel electrophoresis ofDNA fragments in biomonitoring forgenotoxicity: an introductory study on healthy human vol-unteers. IntArch Occup Environ Health 1997;69:185-92.

14 Vaghef H, Wisen A-C, Hellman B. Demonstration ofbenzo(a)pyrene-induced DNA damage in mice by alkaline

single cell gel electrophoresis: evidence for strand breaks inliver but not in lymphocytes and bone marrow. PharmacolToxicol 1996;78:37-43.

15 Hellman B, Vaghef H, Bostrom B. The concepts of tailmoment and tail inertia in the single cell gel electrophore-sis assay. Mutat Res 1995;336: 123-31.

16 Friis L, Engstrand L, Edling C. Prevalence of Helicobacterpylori infection among sewage workers. ScandJ Work Envi-ron Health 1996;22:364-8.

Vancouver style

All manuscripts submitted to Occup EnvironMed should conform to the uniform require-ments for manuscripts submitted to biomedi-cal journals (known as the Vancouver style.)

Occup Environ Med, together with manyother international biomedical journals, hasagreed to accept articles prepared in accord-ance with the Vancouver style. The style(described in full in the JAMA[1]) is intendedto standardise requirements for authors, and isthe same as in this issue.

References should be numbered consecu-tively in the order in which they are first men-tioned in the text by Arabic numerals on theline in square brackets on each occasion thereference is cited (Manson[1] confirmed otherreports[2] [3] [4] [5]). In future references topapers submitted to Occup Environ Medshould include: the names of all

authors if there are seven or less or, if there aremore, the first six followed by et al; the title ofjournal articles or book chapters; the titles ofjournals abbreviated according to the style ofIndex Medicus; and the first and final pagenumbers of the article or chapter. Titles not inIndex Medicus should be given in full.Examples of common forms of references

are:

1 International Committee of Medical Journal Editors.Uniform requirements for manuscripts submitted tobiomed journals. JAAA 1993;269:2282-6.

2 Soter NA, Wasserman SI, Austen KR. Cold urticaria:release into the circulation of histmaine and eosinophilchemotactic factor of anaphylaxis during cold challenge.NEnglJ Med 1976;294:687-90.

3 Weinstein L, Swartz MN. Pathogenic properties of invad-ing micro-organisms. In: Sodeman WA Jr, Sodeman WA,eds. Pathologic physiology, mechanisms of disease.Philadelphia: W B Saunders, 1974:457-72.

498

Occupational carpal tunnel syndrome

17 Lapidus PW, Fenton R. Stenosing tenovaginitis at the wristand fingers. Report of 423 cases in 369 patients with 354operations. American Medical Association Archives ofSurgery1952;64:475-87.

18 Phalen GS. The carpal tunnel syndrome: 17 years'experience in diagnosis and treatment of 654 hands. BoneJoint Surg 1966;48A:211-28.

19 Brooks DM. Nerve compression by simple ganglia. A reviewof 13 collected cases.JBoneJoint Surg 1952;34B:391-400.

20 Grokoest AW, Demartinbi FE. Systemic disease and thecarpal tunnel syndrome. JAMA 1954;155: 635-7.

21 Kendall D. Aetiology, diagnosis, and treatment of paresthe-sia in the hands. BMJ 1960;2:1633-40.

22 Thompson AR, Plewes LW, Shaw EG. Peritendinitiscrepitans and simple tenosynovitis: a clinical study of 544cases in industry. BrJInd Med 1951;8:150-60.

23 Tanzer RC. The carpal tunnel syndrome: a clinical and ana-

tomical study. Jf Bone Joint Surg 1959;41A:626-34.

24 Tanaka S, Wild DK, Seligman J, Halperin WE, Behrens VJ,Putz-Anderson V. Prevalence and work-relatedness of self-reported carpal tunnel syndrome among US workers:analysis of the occupational health supplement data of1988 national health interview survey. AmJrIndMed 1995;27:451-70.

25 Shiller F, Kolb FO. Carpal tunnel syndrome in acromegaly.Neurology 1954;4:271-82.

26 Centers for Disease Control. Occupational diseasesurveillance: carpal tunnel syndrome. MMWRMorb MortalWkly Rep 1989;38:485-9.

27 Miller RS, Iverson DC, Fried RA, Green LA, Nutting PA.Carpal tunnel syndrome in primary care: a report fromASPN. Fam Pract 1994;38:337-44.

28 Stevens JC, Beard CM, O'Fallon WM, Kurland LT. Condi-tions associated with carpal tunnel syndrome. Mayo ClinProc 1992;67:541-8.

29 Hagberg M, Morgenstern H, Kelsh M. Impact of occupa-tions and job tasks on the prevalence of carpal tunnel syn-drome. ScandJ7 Work Environ Health 1992;18:337-45.

Correspondence and editorialsOccupational and Environmental Medicine wel- minimum. Letters are accepted on the under-comes correspondence relating to any of the standing that they be subject to editorial revi-material appearing in the journal. Results from sion and shortening.preliminary or small scale studies may also be The journal also publishes editorials whichpublished in the correspondence column if are normally specially commissioned. Thethis seems appropriate. Letters should be not Editor welcomes suggestions regarding suit-more than 500 words in length and contain a able topics; those wishing to submit anminimum of references. Tables and figures editorial, however, should do so only after dis-should be kept to an absolute cussion with the Editor.

523

Occupational and Environmental Medicine 1997;54:526-528

NOTICES

Changes to asbestos related prescribeddiseases

The Social Security (Industrial Injuries)(Miscellaneous Amendment) Regulations1997 come into force on 9 April 1997.Under these regulations changes in entitle-

ment to disablement benefit will be introducedin relation to the prescription of the followingasbestos related prescribed diseases:PD D3 Mesothelioma (Primary neoplasm

of the mesothelium of the pleura or of thepericardium or of the peritoreum).PD D8 Primary carcinoma of the lung

where there is accompanying evidence ofasbestosis or diffuse pleural thickening.PD D9 Diffuse pleural thickening.

These changes follow on from recommenda-tions of the Industrial Injuries AdvisoryCouncil (IIAC) in its report, AsbestosRelated Diseases (Cm 3467), November1996.

PD D3Under the new regulations the schedule ofprescribed occupations has been broadenedto include any occupation in which there hasbeen "exposure to asbestos, asbestos dust, or

any admixture of asbestos at a level above thatcommonly found in the environment atlarge."

This alteration means that anyone, what-ever their occupation, who is diagnosed as

having mesothelioma, should have an occu-

pational history taken to see whether theyhave ever been exposed to asbestos, even for a

short period, while carrying out their work.Their work may not have involved thehandling of asbestos but may have beencarried out in its presence. If so, they may wellsatisfy the new terms of prescription andshould be advised to submit a claim for Disa-blement Benefit.

In addition, the 90 day waiting periodbetween the onset of the disease and the startof benefit payment has been waived, and willno longer apply to claims for PD D3 whichare adjudicated on or after 9 April 1997.

PD D8 and PD D9Benign diffuse thickening of the pleura iscurrently prescribed only when the conditionis bilateral. Under the new regulations thepleural thickening can be unilateral providedthat it covers at least 50% ofthe chest wall onthe affected side, or bilateral provided that itcovers at least 25 % of the whole chest wall.

Irrespective of whether it is unilateral or

bilateral the pleural thickening must be¢ 5 mm at one point within the area affected,as measured on a plain chest radiograph. Theregulations specify that the thickness must bemeasured on a plain chest radiograph and noton a computerised tomography scan or otherform of imaging.

Enquiries to: Dr P N Stidolph, MedicalPolicy Group, Department of Social Security,542, New Court, Carey Street, London,WC2A 2LS.

Imperial College of Science, Technologyand Medicine. MSc in EnvironmentalTechnology

The MSc in environmental technology pro-vides training in environmental economics,law, policy, science, health and technology. Itis divided into three parts and variousoptions. The core course held in the autumnterm provides a broad interdisciplinary un-derstanding ofthe environment involving law,economics, health and policy with the under-lying science. In the second term, studentsselect one specialist option for in depth study.The third term ofthe MSc is spent on a prac-tical research project and is designed toincorporate career development skills. Manyprojects are done in collaboration with exter-nal organisations.

Environment and healthRecent increases in respiratory problemsincluding asthma; air quality; environmentalproblems in cities; the health impacts of traf-fic pollution, pesticides, radon, and contami-nated land and water; work place hazards;and, more local issues such as leukaemiaclusters around nuclear power plants has ledthe Centre for Environmental Technology toestablish a new specialist option in "Environ-ment and Health". The option explores theseand other health issues in a comprehensivefashion.

This specialist option brings together thewell established training in environmentalscience, technology, and management in theCentre for Environmental Technology withthe expertise of the Imperial College Schoolof Medicine, including St Mary's and theNational Heart and Lung Institute. The pro-gramme of lecture-based modules and casestudies is designed to provide graduates withappropriate interdisciplinary training in sci-entific, medical, and policy issues within theframework of environment and health tomeet the needs of (local) government, indus-try and commerce within the United King-dom, European Union, and the developingworld. Hence, the course is ideal for candi-dates who wish to learn about the relationbetween environmental pollution and impactson human health, or practitioners who wish tolearn more about the latest developments inthis field.The modules in the environment and

health option are: (i) pollution and environ-mental assessment, (ii) epidemiological prin-ciples and methods (iii) evaluation environ-mental hazards/toxicology/risk assessment(iv) environment and health policy. The casestudies are designed to evaluate the toxico-logical and epidemiological evidence of envi-ronmental hazards and the consequences forenvironment and health policy making.The teaching quality on the MSc pro-

gramme has recently been rated the best of itskind by the Higher Education FundingCouncil of England and Wales. The 940graduates since 1977 have been highlysuccessful in gaining environment-relatedemployment. The course is generously sup-ported by the European Social Fund, theESRC, NERC and a favourable loan facility.For further details contact: The AssistantRegistrar (Admissions), Imperial College ofScience, Technology and Medicine, LondonSW7 2AZ; telephone: 0171-594 8046; fax:017 1-594 8004; e-mail: s.matthewsgic.ac.uk

8th Conference of the InternationalSociety for Respiratory Protection.22-25 September 1997. KrasnapolskyGrand Hotel, Amsterdam, Holland

The biennial conference is the focal point forrespiratory protection experts from all overthe world to meet and discuss the latestdevelopments and ideas in the use and designof respiratory protective devices.The conference is divided into sessions of

specific interest, for example research, healthand physiology, air filtration, breathing appa-ratus, international standards, protection fac-tors. All sessions will be conducted in Englishand there will be a product exhibitionrunning in parallel.The registration fee is £315 for the four

days, with reduction for ISRP members, pro-vided payment is received before 31 July1997. To register, or for further informationcontact Frank Hallett on 01708 859101, orJ D Naylor c/o Protector Technologies Ltd,Pimbo Road, West Pimbo, Skelmersdale,Lancashire WN8 9RA, UK. Tel: 0169550284 Fax: 01695 50819.

IOSH '97: Laying the odds-managingrisk safely. 3-5 November. HarrogateInternational Centre

Plenary session speakers at IOSH '97 willfocus on the practical aspects of riskmanagement-from the assessment of risksin design, product development, and pro-curement to safety performance indicators.Other sessions, including professional devel-opment workshops, will cover: contingencyplanning; behaviour modification in practice;volunteers as employees; mental health; man-aging the risk of fire; "selling" risk manage-ment to the board; managing a work relatedupper limb disorder programme; andviolence in the workplace.

Further information from: CarolineWoollatt, IOSH, The Grange, HighfieldDrive, Wigston, Leicestershire, LE18 1NN,United Kingdom; telephone: +44 (0)116-257 3100, extension: 105/108; fax: +44(0)116-257 3101; website: http://www.iosh.co.uk; e-mail: commsgiosh.co.uk

Epidemiology and Occupational Risks.22-24 April 1988. Graz, Austria.

There will be an international symposium onthe role and importance of epidemiologicalstudies in the prevention of and compensa-tion for occupational accidents and diseases.The symposium is organised by the inter-national research section of the InternationalSocial Security Association (ISSA) in coop-eration with the main Austrian social insur-ance against occupational risks (AUVA).The objective of the meeting is to review

experiences of guidance to good practice inepidemiology and to identify further im-provements, to consider obstacles and ethicalissues in conducting occupational epidemiol-ogy, and to discuss approaches for the criticalinterpretation and synthesis of the results.The symposium will also review experiencesand expectations for the use of epidemiologi-cal evidence by those working in prevention,compensation, or regulation.One of the main topics of the symposium is

epidemiology: methods, quality criteria, and

526

Notices, Corrections, Book reviews

interpretation, the other main topic is epidemi-ology and those working in health and safety atwork.The meeting will be ofparticular interest to

representatives of authorities responsible forthe establishment of occupational exposurelimits or the definition of lists of occupationaldiseases, medical inspectors of workplaces,occupational physicians, safety engineers,representatives of the social groups, the socialsecurity institutions, and occupational epide-miologists.

Further information from: the Office forInternational Relations and Conferences,Adalbert-Stifter-Strasse 65, A-1200 Vienna,Austria. Tel. +43-1-33 111 - 537, Fax+43-1-33 111 469 email: pressegauva.or.at

International Symposium on GoodOccupational Health Practice andEvaluation of Occupational HealthServices. 8-10 June 1998. HanasaariCultural Centre, Espoo, Finland

The symposium is organised by the FinnishInstitute of Occupational Health (FIOH), theMinistry of Social Affairs and Health, Fin-land, and the International Commission onOccupational Health (ICOH), ScientificCommittee on Health Services Research andEvaluation in Occupational Health.The aim of this symposium is to stimulate

and to promote the international exchange ofexperiences on achieving good occupationalhealth service practices and to promote devel-opment of concepts, strategies, andmethodology in evaluating occupational healthservices (OHS). Topics included in this areaare quality and effectiveness, multidisciplinar-ity, flexibility and good practices with regard toneeds of clients and consumers' demands,research on OHS as an advisory servicecontributing to rational decision making onnational, regional, and local levels, as well as onthe enterprise level or the OHS service unitlevel, and the interaction between scientificinstitutions, service providers, and the healthservice market. Considering the broad scope ofthe subject matter of the symposium, issuesrelated to world wide trades and working lifeare also included.The programme will include plenary lec-

tures, oral and poster presentations, as well aspanel discussions. The working language ofthe Symposium is English.

Topics include:* Good occupational health practice, focus-

ing on workplace evaluation and systemsevaluationKeynote lecture: Global trends and devel-

opments in occupational health services(objectives and inputs); Jerry Jeyaratnam,ICOH, SingaporeKeynote lecture: Good occupational health

practices: Concepts and criteria; Frank vanDijk, The Netherlands* EvaluationKeynote dialogue: Strategies and methods

for scientific evaluation of occupationalhealth services; Peter Westerholm, Swedenand Kaj Husman, Finland* Future perspectivesKeynote lecture: Challenges of occupa-

tional health services in changing societiesand working life; Jorma Rantanen, Finland* Other topics related to good occupational

health practice and occupational healthservice evaluation

Further information from: Symposium onGood Occupational Health Practice andEvaluation of Occupational Health ServicesFinnish Institute of Occupational HealthSymposium Secretariat, Inkeri HaatajaTopeliuksenkatu 41 a A, FIN-00250 Hel-sinki, Finland; telephone: Int.+358-9-4747470; fax: Int.+358-9-474 7548; e-mail:Inkeri.Haatajaqoccuphealth.fi www: http://www.occuphealth.fi/tiedotus

CORRECTIONS

Correlation between "Tc--HMPAO-SPECT brain image and a history ofdecompression illness or extent of divingexperience in commercial divers TGShields, PM Duff, SA Evans, HG Gemmell,PF Sharp, FW Smith, RT Staff, SE Wilcock(1997;54:247-253).

The bottom row of table 2 should read TotalII-V, not I-V. The address for S E Wilcockshould be only the Hyperbaric ResearchUnit, Robert Gordon University, School Hill,Aberdeen AB9 1FR.

Cancer mortality among magazineprinting workers Daniele Luce,Marie-France Landre, Thierry Clavel,Isabelle Limousin, Sylvie Dimerman,Jean-Jacques Moulin(1997;54:264-7)

Page 266 column 2 line 4 should read <1 gg,not <1 g. Also in table 2 for oesophagus< 1970, the expected number should be 0.20,not 2.20.

BOOK REVIEWS

Mechanisms of fibre carcinogenesis:IARC Scientific Publications No 140.Edited by AB KANE, P BOFFETTA, R SARACCI, JDWILBOUR. (Pp 135; £45). 1996. Lyon: IARC.ISBN: 92832-2140-0.

This book represents a collection of reviewswritten by the participants in a workshop on

the mechanisms of fibre carcinogenesis, heldat the LARC in Lyon on 9-11 January, 1996.The goals of the workshop were twofold; to

review and discuss the current knowledge on

the mechanisms of fibre carcinogenesis, andto use this knowledge in the assessment ofcarcinogenic risks to humans or animals.The primary outcome of the workshop was

the consensus report, which is presented inthe first part of the book, and was agreed byall the workshop participants. This reportbrings to light a surprising number ofweaknesses and data gaps in the available lit-erature on fibre characterisation, genotoxic-ity, cell proliferation or activation, and animal

studies. A prime example of such shortcom-ings is the general lack of information on thecharacterisation of fibre dose-that is, num-bers, dimensions, surface area, chemistry,durability, and biopersistence-for most invitro and in vivo studies. The report also dis-cusses the relevance of mechanistic data fromin vitro and in vivo assays for the evaluation ofcarcinogenic risk to humans and concludeswith several recommended experimentalstudies which would provide additional datafor the future assessment of fibre carcino-genicity.The remainder of the book focuses on

various aspects of mineral fibre carcinogenic-ity which were outlined in the consensusreport, and such reviews express the opinionsof their authors. Briefly, the paper by Kaneprovides a good discussion of the proposedfive mechanistic hypotheses for fibre carcino-genesis. Fubini follows up on these hypoth-eses by examining the interactions betweenfibres and cells through the analysis of fibreparameters such as crystallinity, micromor-phology, elemental analysis, solubility, andadsorption, which are often not consideredby most investigators. The report by Jaurandprovides cautious consideration to the limita-tions and feasibility of mutation and celltransformation assays for investigating themechanistic effects of fibres. Topics presentedby Driscoll focus on processes which maycontribute to the neoplastic effects of variousfibres and current issues such as signal trans-duction pathways, oxidative stress, antioxi-dant mechanisms, and protooncogene ex-pression. Donaldson describes in detail therole of reactive oxygen species, cytokines, andgrowth factors in preneoplastic and fibroticchanges. The advantages and disadvantagesof inhalation, intratracheal instillation, andintracavitary injection are reviewed by Ober-dorster. The final review, by Davis, discussesthe interactions of inhaled particulate matteralong with fibres and the potential effects ofmixed doses on fibre pathogenicity.

Overall this book is a collection of conciseand up to date reviews on the subject of fibre(mainly asbestos) carcinogenesis. It is gener-ally readable, clear, and informative. Its com-prehensive tables and references provides avery good introduction for newcomers to thesubject, as well as being an excellent resourcefor examination candidates. Unfortunately,the most appropriate readers (students) willbe unable to afford its high price. Thesections in the reviews on recommendedexperimental studies and unanswered ques-tions are worthwhile to the professional audi-ence. These sections state clearly the direc-tions that research should take to close gapsin data and strengthen current information.There are several similar books on the markettoday which deal with the health effects andactions of mineral dusts; this book will be ofinterest to those investigators who workpredominately with asbestos fibres.

KELLY ANN BERUBE

Immunopathology of Lung DiseaseEdited by RICHARD L KRADIN, BRUCE WSROBINSON (pp 578; £87.99) 1997. Oxford:Butterworth-Heinemann. ISBN: 0-7506-9282-0.

This is the first comprehensive text book onthe immune responses of the lung in healthand disease since Immunology of the Lung andUpper Respiratory Tract, edited by John Bien-enstode, was published in 1984. The book

527